How is pulmonary artery stenosis treated?

If your child is diagnosed with pulmonary artery stenosis, your pediatrician or primary care doctor will recommend that you meet with a congenital heart specialist (a doctor who has the training and equipment to determine your child’s heart problem and order the necessary special tests, medical care, heart surgery, and follow-up checkups). The best treatment approach will depend on your child’s symptoms as well as other characteristics of the stenosis. Mild to moderate narrowing in one or more pulmonary artery branches usually does not require treatment, but severe cases do require some form of therapy. Available treatments include:

Balloon dilation

This treatment method consists of moving a balloon dilation catheter into the narrowed area of the artery. The balloon is carefully inflated – first under low pressure and then under higher pressure – until the narrowed area is widened. The balloon is then deflated and removed. Although the narrowing is improved in a majority of patients following balloon dilation, overtime the artery can again become narrow in as many as 15% to 20% of cases, requiring further ballooning. Different types of balloons are currently being developed that will likely lead to better and longer-lasting results.

Balloon dilation and stent placement

In an effort to improve on the results of balloon dilation, a search for a more effective treatment was begun and led to the development of the stainless steel balloon-expandable stent. Stent placement is accomplished by positioning the stent across the narrowed segment of the artery. The stent is mounted on a balloon angioplasty catheter and covered with a sheath as it is moved into position. The sheath then is withdrawn off the stent-balloon angioplasty assembly and the balloon is inflated to its recommended pressure, expanding the stent and anchoring it in place.

The Cutting Balloon Image with permission, from Boston Scientific Corporation

The Cutting Balloon™

This procedure is similar to standard balloon dilation but the balloon has been specially designed with small blades running up and down its length. When the balloon is inflated, the blades are activated and they cut through the narrowed area, making the vessel easier to dilate and resulting in a larger opening. Cutting balloons are available in different sizes.

Surgery

Various methods of surgical repair of pulmonary artery stenosis are used, the choice of which depends on the characteristics of the stenosis and the surrounding vessels and other structures.

Last reviewed by a Cleveland Clinic medical professional on 02/21/2019.

References

  • Darst JR, Collins KK, Miyamoto SDCardiovascular Diseases. In: Hay WW, Jr., Levin MJ, Deterding RR, Abzug MJ. eds. CURRENT Diagnosis & Treatment: Pediatrics, 22e. New York, NY: McGraw-Hill; 2013.
  • American Heart Association. About Congenital Heart Defects Accessed 3/12/2015.
  • Centers for Disease Control and Prevention. Facts about Congenital Heart Defects Accessed 3/12/2015.
  • National Heart, Lung, and Blood Institute. What are Congenital Heart Defects? Accessed 3/12/2015.
  • Hirsh JC, Devaney EJ, Ohye RG, Bove EL. Chapter 19B. The Heart: II. Congenital Heart Disease. In: Doherty GM. eds. CURRENT Diagnosis & Treatment: Surgery, 13e. New York, NY: McGraw-Hill; 2010.

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